Join the EIG agent network

Agent application

About 5 minutes. Sensitive details like SSN and banking are collected later on a secure contracting step.

About you

Contracting as *

First name *Last name *Email *Cell phone *Business phonePersonal NPN

Address

States you plan to write most of your business in

1. Do you have any indebtedness to an insurance company?
2. Have you ever been convicted of a felony, or a misdemeanor, or are there charges pending?
3. Are you in process of, or have you ever filed for, bankruptcy?
4. Are you now, or have you ever been, employed by or associated with an agency in a capacity other than an agent?
5. Are you now the subject of any complaint, investigation, or proceeding by a regulatory agency?
6. Have you ever been refused a bond or Errors & Omissions coverage?
7. Have you ever had your insurance license suspended or revoked?
8. Have you been fined or had disciplinary action taken against you by any insurance department?
9. Are you at present, or within the past five years, involved in any lawsuit with an insurance company?
10. Have you ever been denied an appointment with any insurance company?
11. Have you ever been terminated for cause by any insurance company?

A "yes" doesn't automatically disqualify you — we'll follow up for details.

Have you taken an Anti-Money Laundering course in the past 2 years?

Are you a Registered Rep with FINRA?

Anything else we should know?

I confirm the information above is accurate and agree to be contacted by EJ Insurance Group about my application.

Your details are only visible to EIG leadership.